Provider Demographics
NPI:1396096566
Name:HOLISTIC HARVEST: AN INTEGRATIVE COUNSELING CENTER
Entity type:Organization
Organization Name:HOLISTIC HARVEST: AN INTEGRATIVE COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:CLAIRE
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:LCAS,LPC,CSI
Authorized Official - Phone:252-531-9130
Mailing Address - Street 1:PO BOX 212
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27894-0212
Mailing Address - Country:US
Mailing Address - Phone:252-495-4613
Mailing Address - Fax:252-260-5727
Practice Address - Street 1:703 NASH ST W STE D
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-3058
Practice Address - Country:US
Practice Address - Phone:252-495-4613
Practice Address - Fax:252-260-5727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-27
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1693251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6112230Medicaid